Can health insurance cover past medical bills?

The insurance company is responsible for processing the claim for your old medical bill as long as the insurance was in effect on the date the medical services were provided. Your insurance will only cover a previous medical bill if that insurance was in effect on the date the medical services were provided. If you didn't have current health insurance on the date of service, no new insurance will pay that old medical bill. People without health coverage are exposed to these costs.

Sometimes, this can lead people without coverage to go into deep debt or even go bankrupt. In approving the Iowa retroactive coverage exemption, CMS concluded that the objectives of the Medicaid program are promoted “by encouraging beneficiaries to obtain and maintain health coverage, even when they are healthy.” The views expressed here are personal opinions and do not represent the point of view of any employer or insurance company. Despite the requirements that Section 1115 exemptions have an experimental, pilot or demonstration purpose and have an evaluation component, little is known about the impact of retroactive coverage exemptions on beneficiaries and providers. BeneHQ helps human resources professionals, insurance brokers and employees better understand their benefits.

When sudden healthcare needs arise, the initial approach is usually to stabilize an individual's medical condition. If your health insurance is not yet in effect and you can safely delay any medical service until after the effective date, you must do so. If you enroll in your health insurance in the Health Insurance Marketplace, you'll know the effective date when you enroll. Without annual or lifetime limits, Marketplace health plans cannot place limits in dollars on the amount they will spend each year or throughout their lifetime to cover.

Some other states have retroactive coverage exemptions prior to the ACA and may have been associated with achieving the budgetary savings needed to expand coverage before federal law authorized the use of Medicaid funds for adults without children. Retroactive coverage exemptions have been approved in a limited number of other states with certain conditions. Some people may not qualify for Medicaid until after having experienced a traumatic event, such as a stroke that requires hospitalization and ongoing long-term care needs, or a motorcycle accident that results in a traumatic brain injury. To meet the need for reliable information on national health issues, the Kaiser Family Foundation is a non-profit organization based in San Francisco, California.

Once the plan year ends, the new insurance coverage will not cover any old medical bills with a service date prior to the effective date of the new coverage. The percentage of the costs for a covered health care service that you pay (20%, for example) after you've paid your deductible.

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